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Meuwese RT, Versteeg EM, van Drongelen J, de Hoog D, Bouwhuis D, Vandenbussche FP, van Kuppevelt TH, Daamen WF. A collagen plug with shape memory to seal iatrogenic fetal membrane defects after fetoscopic surgery. Bioact Mater 2023; 20:463-471. [PMID: 35800408 PMCID: PMC9249610 DOI: 10.1016/j.bioactmat.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/20/2022] [Accepted: 06/12/2022] [Indexed: 12/04/2022] Open
Abstract
Iatrogenic preterm premature rupture of fetal membranes (iPPROM) after fetal surgery remains a strong trigger for premature birth. As fetal membrane defects do not heal spontaneously and amniotic fluid leakage and chorioamniotic membrane separation may occur, we developed a biocompatible, fetoscopically-applicable collagen plug with shape memory to prevent leakage. This plug expands directly upon employment and seals fetal membranes, hence preventing amniotic fluid leakage and potentially iPPROM. Lyophilized type I collagen plugs were given shape memory and crimped to fit through a fetoscopic cannula (Ø 3 mm). Expansion of the plug was examined in phosphate buffered saline (PBS). Its sealing capacity was studied ex vivo using human fetal membranes, and in situ in a porcine bladder model. The crimped plug with shape memory expanded and tripled in diameter within 1 min when placed into PBS, whereas a crimped plug without shape memory did not. In both human fetal membranes and porcine bladder, the plug expanded in the defect, secured itself and sealed the defect without membrane rupture. In conclusion, collagen plugs with shape memory are promising as medical device for rapid sealing of fetoscopic defects in fetal membranes at the endoscopic entry point. Shape memory can be given to collagen plugs to rapidly expand in aqueous fluids. Within 1 min in aqueous fluid, collagen plugs with shape memory triple in diameter. Collagen plugs with shape memory show potency to seal fetal membrane defects.
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Jung YM, Park CW, Park JS, Jun JK, Lee SM. Application of Tissue Engineering and Regenerative Medicine in Prelabor Rupture of Membranes: a Review of the Current Evidence. Reprod Sci 2021; 28:1774-1784. [PMID: 33847975 DOI: 10.1007/s43032-021-00525-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
Preterm prelabor rupture of membranes (PPROM) is the main cause of preterm delivery, resulting in increased perinatal morbidity and mortality. Several techniques have been studied for the healing of ruptured membranes, with some success. Before new techniques using tissue/organ engineering are applied in clinical practice, these techniques must be validated in clinical trials. To address this issue, the objective of this study was to summarize the current literature on interventions to seal or heal the amniotic membranes after PPROM. An electronic search was conducted using the keywords "fetal membranes," "premature rupture," "amnion," "tissue engineering," "fibrin tissue adhesive," "regenerative medicine," "tissue adhesive," "wound healing," and "fetoscopy" through the MEDLINE, Embase, and Cochrane CENTRAL databases, with the limitation of English-language studies. Through a review of the identified studies, it was found that spontaneous healing of the fetal membrane has not been successful. Several efforts have been made to seal membranes before or after rupture using different methods, including amniopatches, collagen, tissue patches, fibrin sealant, mussel-mimetic sealant, engineered cell matrix, and immunological supplements. However, most studies have been conducted in ex vivo or in vivo settings, so the safety and applicability of these techniques to spontaneous rupture of membranes in clinical settings have not been sufficiently tested. Overall, the current evidence is limited regarding the safety and effectiveness of interventions against PPROM.
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Affiliation(s)
- Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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Engels AC, Joyeux L, Van der Merwe J, Jimenez J, Pranpanus S, Barrett DW, Connon C, Chowdhury TT, David AL, Deprest J. Tissuepatch is biocompatible and seals iatrogenic membrane defects in a rabbit model. Prenat Diagn 2017; 38:99-105. [PMID: 29178347 DOI: 10.1002/pd.5191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate novel sealing techniques for their biocompatibility and sealing capacity of iatrogenic fetal membrane defects in a pregnant rabbit model. METHOD At day 23 of gestation (term = d31), a standardized fetoscopy was performed through a 14G cannula. The resulting fetal membrane defect was closed with condensed collagen, collagen with fibrinogen, Tissuepatch, Duraseal, or a conventional collagen plug (Lyostypt) as reference. At d30, the fetuses were harvested and full thickness fetal membrane samples were analyzed. The study consisted of 2 consecutive parts: (1) biocompatibility testing by fetal survival, apoptosis, and infiltration of polymorphonuclear cells in the membranes and (2) the efficacy to seal fetal membrane defects. RESULTS Three sealants (collagen with fibrinogen, Duraseal, or Lyostypt) were associated with a higher fetal mortality compared to control unmanipulated littermates and hence were excluded from further analysis. Tissuepatch was biocompatible, and amniotic fluid levels were comparable to those of control untouched littermates. Compared to the condensed collagen, Tissuepatch was also easier in surgical handling and induced limited cell proliferation. CONCLUSION Tissuepatch had the best biocompatibility and efficacy in sealing an iatrogenic fetal membrane defect in the pregnant rabbit compared to other readily available sealants.
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Affiliation(s)
- Alexander C Engels
- Department of Development and Regeneration, Organ Systems, University Hospital Gasthuisberg, Leuven, Belgium.,Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospital Gasthuisberg, Leuven, Belgium
| | - Luc Joyeux
- Department of Development and Regeneration, Organ Systems, University Hospital Gasthuisberg, Leuven, Belgium
| | - Johannes Van der Merwe
- Department of Development and Regeneration, Organ Systems, University Hospital Gasthuisberg, Leuven, Belgium.,Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospital Gasthuisberg, Leuven, Belgium
| | - Julio Jimenez
- Department of Development and Regeneration, Organ Systems, University Hospital Gasthuisberg, Leuven, Belgium.,Department of Obstetrics and Gynecology, Clinica Alemana Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Savitree Pranpanus
- Department of Development and Regeneration, Organ Systems, University Hospital Gasthuisberg, Leuven, Belgium
| | - David W Barrett
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Che Connon
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, Newcastle upon Tyne, UK
| | - Tina T Chowdhury
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Anna L David
- Research Department of Maternal Fetal Medicine, Institute of Women's Health, University College London, London, UK.,Research & Development, NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Jan Deprest
- Department of Development and Regeneration, Organ Systems, University Hospital Gasthuisberg, Leuven, Belgium.,Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospital Gasthuisberg, Leuven, Belgium.,Research Department of Maternal Fetal Medicine, Institute of Women's Health, University College London, London, UK
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Engels AC, Bauters D, Rynkevic R, Pranpanus S, Richter J, van Mieghem T, Hoylaerts MF, Deprest JA. Thrombin Generation by Fetoscopic Trauma to the Fetal Membranes: An in vivo and in vitro Study. Fetal Diagn Ther 2015; 39:261-8. [PMID: 26426691 DOI: 10.1159/000439304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/06/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We first aimed to investigate in vivo thrombin generation induced by fetoscopy, and second we used term membrane explants for measurement of thrombin generation, thrombin receptor location and induction of selected matrix metalloproteinases (MMPs) in tissue culture. MATERIALS AND METHODS In vivo study (37 cases): samples of amniotic fluid were taken at the beginning and end of fetoscopy (mean gestational age 26.7 weeks) and analyzed by ELISA for thrombin-antithrombin complexes. In vitro study: fetal membranes were put in culture and punctured for measurement of thrombin generation by calibrated automated thrombography and ELISA. Induction of MMP-9 and MMP-2 was analyzed by zymography. PAR-1 was localized by immunohistochemistry. RESULTS No significant increase in thrombin-antithrombin was measured in amniotic fluid obtained during fetoscopy. In vitro, thrombin generation induced by needle trauma of membrane cultures is correlated to the amount of plasma. Activity of MMP-9 but not MMP-2 was elevated in cultured membranes but could not be inhibited by a thrombin inhibitor. On histology, the thrombin receptor PAR-1 was located in the chorion and decidua, but not in the amnion. DISCUSSION Despite the influence of thrombin on punctured fetal membranes in vitro, the role of thrombin in iatrogenic preterm premature rupture of membranes is questionable.
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Affiliation(s)
- Alexander C Engels
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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Engels AC, Van Calster B, Richter J, DeKoninck P, Lewi L, De Catte L, Devlieger R, Deprest JA. Collagen plug sealing of iatrogenic fetal membrane defects after fetoscopic surgery for congenital diaphragmatic hernia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:54-59. [PMID: 23801588 DOI: 10.1002/uog.12547] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To investigate the efficacy of collagen plugs at reducing the risk of preterm premature rupture of membranes (PPROM) after fetoscopic surgery for congenital diaphragmatic hernia (CDH). METHODS This was a single-center cohort study on all consecutive cases undergoing fetoscopic endoluminal tracheal occlusion (FETO) for severe or moderate CDH, between April 2002 and May 2011 (n = 141). Cases either received a collagen plug for sealing the fetal membrane defect after FETO or did not, depending on the operating surgeon. The principal outcome measure was the time from fetal surgery to PPROM, further referred to as 'latency'. A multivariable Cox regression model was used to investigate the association between collagen plug and latency while adjusting for risk factors for PPROM. RESULTS Of the 141 cases, 54 (38%) received a collagen plug and 87 (62%) did not. Sixty cases experienced PPROM, 26 among cases with and 34 among cases without a plug (48 vs 39%). The hazard ratio of plug use was 1.29 (95% CI, 0.76-2.19), which does not exclude a potentially increased risk for PPROM when a collagen plug is used. For cases with a plug, 24% had PPROM before balloon removal and 24% had PPROM after elective balloon removal. For cases without a plug, these rates were 30 and 9%, respectively. Perinatal outcomes were similar in both groups. CONCLUSIONS No evidence was found that collagen plugs reduce the risk of PPROM after FETO for CDH.
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Affiliation(s)
- A C Engels
- KU Leuven, Centre for Surgical Technologies, Leuven, Belgium
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